Should We All Take Aspirin to Prevent Heart Disease?


“Should We All Take Aspirin to Prevent Heart Disease?” Salicylic acid, the active ingredient in aspirin, has been used for thousands of years as an anti-inflammatory pain killer in the
form of willow tree bark extract, which Hippocrates used to treat fever and
to alleviate pain during childbirth. It became trademarked as a drug in 1899, and
remains to this day probably the most commonly used drug in the
world. One of the reasons it remains so popular,
despite the fact that we have better painkillers now,
is that it also acts as a blood thinner. Millions of people now take aspirin on a daily
basis to treat or prevent heart disease. It all started back in 1953, with the publication
of this landmark study in the New England Journal of Medicine, “Length of Life and Cause of Death in Rheumatoid
Arthritis.” The paper started out with the sentence, “It has often been said that the way to
live a long life is to acquire rheumatism.” They found fewer deaths than
expected from accidents, which could be explained by the fact that
people with arthritis probably aren’t out, you know, going skiing, but also significantly
fewer deaths from heart attacks. Maybe it was all the aspirin they
were taking for their joints that was thinning their blood and preventing
clots forming in their coronary arteries. And so, in the 1960s there were calls to study
whether aspirin would help those at risk for blood clots. And in the 1970s, we got our wish, studies suggesting regular aspirin intake
protects against heart attacks. Today, the official recommendation
is that low-dose aspirin is recommended for all patients
with heart disease, but in the general population, for those without
a known history of heart disease or stroke, daily aspirin
is only recommended when the heart disease benefits outweigh the
risks of bleeding. The bleeding complications associated with
aspirin use may be considered an underestimated hazard
in clinical medical practice. For those who’ve already had a heart attack,
the risk–benefit analysis is clear. If you took 10,000 patients, daily low-dose
aspirin use would be expected to prevent approximately 250 major vascular events,
such as heart attacks, strokes, or, the most major event of all, death. But, that same aspirin would be expected
to cause approximately 40 major extracranial bleeding events, meaning bleeding so bad you have
to be hospitalized. Thus, the net benefit of aspirin for
secondary prevention, meaning like preventing your
second heart attack, would substantially exceed the
bleeding hazard. For every 6 major vascular
events prevented, only about 1 major bleeding event
would occur; so, the value of aspirin for secondary prevention
is not disputed. But, if you instead took 10,000 patients who
never had a heart attack or stroke— yet, and tried to use aspirin to
prevent clots in the first place, so-called primary prevention, daily low-dose
aspirin would only be expected to prevent 7 major vascular events, at the
cost of causing a hemorrhagic stroke, bleeding within the brain, along with 3 other
major extracranial bleeding events. So then, the benefits are only like 2 to 1,
which is a little too close for comfort, which is why the new European guidelines do
not recommend aspirin for the general population, especially given the additional risk of
aspirin causing smaller bleeds within the brain as well. If only there were safe, simple,
side effect-free solution… and there is. Ornish and Esselstyn proved that even advanced
crippling heart disease could not only just be prevented and treated
but reversed with a plant-based diet, centered around grains, beans,
vegetables, and fruits, with nuts and seeds treated as condiments, and no oils, dairy, meat, poultry, or fish. Bill Castelli, long-time director of
the longest running epidemiological study in the world—
the famous Framingham Heart Study, was once asked what he would do to reverse the coronary artery disease epidemic
if he were omnipotent. His answer? “Have the public eat the diet [of the rural
Chinese] as described by Dr. T. Colin Campbell.” In other words, he told PBS, “If Americans ate
healthy enough, the whole heart disease epidemic would disappear,” though Esselstyn clarifies, we’re not
just talking about vegetarianism. “This new paradigm” of heart disease reversal
means “exclusively plant-based nutrition.”